M4M Cat Adoption Application

Mountaineers For Mutts (M4M) Cat Adoption Application
Date *

- Month - Day Year
Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
E-mail *
Employer *
The cat I am interested in is:
Cat Name *
Breed *
I want to *

Foster this cat Adopt this cat
Do you have any other pets at home? *

Yes No Other option
Current pets?

Dog(s) Cat(s) Bird(s) Small & Furry Other option
How many of each do you have?
Please list your current pets and additional information about them below.
Dog 1 Name and Age:
Dog 1: Altered?

Yes No Other option
Dog 1: Current on these vaccinations:

Rabies Distemper/Parvo combo Lyme Bordetella Other option
Dog 1 lives

Indoors Outdoors Indoors/Outdoors Other option
If you have more than one dog, please list the others here: name, age, altered, current on vaccinations & where does it live? *
Cat 1 Name and Age
Cat 1 Altered?

Yes No Other option
Cat 1: Current on these vaccinations:

Rabies Combo Vax Other option
Cat 1 lives

Indoor only Outdoor only Indoor/Outdoor We have a cat door so cat is free to come/go Other option
If you have more than one cat, please list the others here: name, age, altered, current on vaccinations & where does it live?
Have you had other animals as pets in the past?

Yes No My parents had them when I was a child, but I haven't yet had my own as an adult. Other option
If yes, what happened to them?
Veterinarian Name *
Veterinarian Phone *
Veterinarian City & State *
Do you own or rent? *

Own Rent Other option
If you rent, does your lease allow pets? *

Yes No Not applicable. I own my home. Other option
Renters please list landlord name
Renters please list landlord phone
Do all the adults in your household know you plan to adopt? *

Yes No Other option
Are there children in the home? *

Yes No Other option
Ages of children?
Does anyone in your household have any known allergies to animals?

Yes No Other option
Are you financially prepared to give this cat routine and emergency medical care?

Yes No Other option
Should be Empty: